Midwives’ knowledge and attitudes when

International Journal of Qualitative Studies on Health
and Well-being
ISSN: (Print) 1748-2631 (Online) Journal homepage: http://www.tandfonline.com/loi/zqhw20
Midwives’ knowledge and attitudes when
encountering Gender-Based Violence in their
practice at a maternity-hospital in Kingston,
Jamaica
Cynthia Pearl Pitter MScN Ed, Advanced Cert. Nursing Admin, RM, RN
To cite this article: Cynthia Pearl Pitter MScN Ed, Advanced Cert. Nursing Admin, RM, RN (2016)
Midwives’ knowledge and attitudes when encountering Gender-Based Violence in their practice at a
maternity-hospital in Kingston, Jamaica, International Journal of Qualitative Studies on Health and
Well-being, 11:1, 29358, DOI: 10.3402/qhw.v11.29358
To link to this article: http://dx.doi.org/10.3402/qhw.v11.29358
© 2016 C. P. Pitter
Published online: 15 Feb 2016.
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Date: 14 March 2017, At: 04:12
International Journal of
Qualitative Studies
on Health and Well-being
æ
EMPIRICAL STUDY
Midwives’ knowledge and attitudes when encountering
Gender-Based Violence in their practice at a maternityhospital in Kingston, Jamaica
CYNTHIA PEARL PITTER, MScN Ed, Advanced Cert. Nursing Admin, RM, RN
The UWI School of Nursing Mona, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
Abstract
Introduction: Gender-based violence (GBV) can have devastating consequences for pregnancy because both mother and
child are at risk. Midwives are in a strategic position to identify and empower pregnant women experiencing GBV; however,
currently midwives in Jamaica are not required to screen for GBV, neither are they prepared to do so.
Aim: This study forms the baseline of a larger study designed to improve the capacity of midwives to identify and treat
pregnant women experiencing GBV in Jamaica. This specific component assessed midwives’ knowledge and attitudes when
encountering GBV in their practice in Kingston, Jamaica.
Methods: A qualitative study design was used. Six practicing midwives were purposely selected to participate in a focus
group discussion at the antenatal clinic of a hospital in Kingston, Jamaica.
Results: All six respondents said it was very important to screen for GBV among pregnant women in their care. The
findings from their report revolved around six themes, namely midwives have suboptimal knowledge, are exposed to women
experiencing GBV in pregnancy, lack professional preparedness, report gaps in the institutional framework to guide their
practice, are concerned for their safety and security, and are willing to intervene.
Conclusion: This study confirmed that midwives are aware of the problem and are willing to intervene but are faced with
lack of formal procedures to detect and treat pregnant women who are experiencing GBV. Findings could be used to inform
a protocol which is being developed to guide midwives’ practice. Findings could also be incorporated in the national strategy
to eliminate GBV.
Key words: Gender-based violence, knowledge, attitudes and practices, midwives
(Accepted: 4 January 2016; Published: 15 February 2016)
Midwives as reproductive health practitioners are
in a strategic position to mitigate intergenerational
violence by identifying and making the appropriate
referrals for pregnant women who are victims of
gender-based violence (GBV) (Taket et al., 2003).
Studies have shown that up to 32.5% of all pregnant
women, especially those in developing countries, experience GBV (Ezeanoche, Olagbuji, Ande, Kubeyinje,
& Okonofua, 2011; Nasir & Hyder, 2003). In Jamaica,
where this study was conducted, Pitter and Dunn
(2015, unpublished study) found that 36% of
pregnant women are being physically, emotionally,
financially, and/or sexually abused by their intimate
partners. The majority of women who experience
GBV will not disclose their abuse unless they are
asked directly (Burris & Jaffe, 1984). However, some
women in this situation wish that [health care pro-
viders] would ask them about it (Scheffer Lindgre &
Renck, 2008).
GBV in the general population can lead to homicides, suicides, or result in negative health outcomes
such as HIV infection, as well as unwanted and
unplanned pregnancies for women (Dunkle et al.,
2004). GBV during pregnancy increases the risk of
the pregnancy becoming ‘‘high risk’’, leading to miscarriages, stillbirths, or premature labour (Lazenbatt
& Thompson-Cree, 2009; The Royal College of
Midwives, 1999).
Midwives are entrusted to monitor pregnant women
to ensure safe pregnancies and deliveries. They are
in a strategic position to successfully manage GBV
and are among the first to see victims and survivors
of such violence [Fraser & Cooper, 2009; Lauti
& Miller, 2008; The Forty-Ninth World Health
Correspondence: C. P. Pitter, The UWI School of Nursing Mona, Faculty of Medical Sciences, University of the West Indies, 9 Gibraltar Camp Way, Mona,
Kingston 7, Jamaica. E-mail: [email protected]
# 2016 C. P. Pitter. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and
build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
Citation: Int J Qualitative Stud Health Well-being 2016, 11: 29358 - http://dx.doi.org/10.3402/qhw.v11.29358
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C. P. Pitter
Assembly (WHA 49.25), 1996]. Mezey, Bacchus,
Haworth, and Bewley (2003) agreed that midwives
are aware of their responsibilities to women experiencing GBV but they rarely enquire about abuse.
Researchers like Lazenbatt and Thompson-Cree
(2009); the Royal College of Midwives (1999);
Baachus, Mezey, Bewley, and Haworth (2004) agreed
with Mezey et al. (2003) that there are many contributing factors that are preventing midwives from
enquiring about GBV. Among the factors reported by
midwives were lack of time, lack of confidence, having
safety concerns, shortage of staff, low staff morale,
personal experiences with GBV, and lack of professional preparedness and formal procedures to guide
their practice.
The current study which is being done in Jamaica
has revealed that Jamaican midwives are not required
by law to screen for or report cases of GBV. It has
also emerged that many cases of pregnant women
experiencing GBV are not detected. The lack of
screening for GBV by midwives may be a factor
contributing to Jamaica’s inability to achieve Millennium Development Goals (MDGs) #35, which
promote gender equality, the empowerment of
women, and child and maternal health.
Little is known about Jamaican midwives’ knowledge and attitudes when encountering GBV in their
practice and how these may be influencing pregnant
women’s willingness to disclose their experiences in
antenatal clinics. The study has enabled midwives to
identify the gaps while empowering them to become
part of the process to eliminate GBV in Jamaica.
Theoretical perspectives
The absence of systems for GBV screening in the
health sector can be explained by patriarchy as a
reflection of a system of unequal power. Feminists
argue that patriarchy is an institution or system that
promotes dominance and control by men (Wilson,
2000). Fraser and Cooper (2009) argued that issues
that mainly affect women, such as screening for
GBV are not considered to be a priority within large
institutions where the management team is mainly
male dominated. The absence of screening for GBV
in maternity care could be regarded not only as a
reflection of patriarchy in the health system but also
a form of ‘‘institutional silence’’ on GBV. Professions
dominated by females such as midwifery are historically considered subordinate to medical doctors the,
majority of whom were men, in a field that was
traditionally male dominated. Midwives are among
the 80% of women employed in the health care system but as a group seem to have less power at the
highest levels of decision-making in the health
system (World Health Organization, 2009). This is
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significant because male dominance may eliminate
the voice of those employed at the lower levels, the
majority of whom are females. The medical model
that is practiced in Jamaica’s health care system may
be viewed as one that obscures rather than elucidates
knowledge of abuse and one that puts [midwives]
under institutional constraints (Warshaw, 1989).
The current study has recognized that midwives
are ideally placed, as agents of change that can
emancipate and empower not only women who are
experiencing abuse but also professional midwives
who may also be experiencing abuse. The time has
come for the campaign against GBV to be broadened
to include the health care system, to value the role
of midwives, and to encourage them to be more
responsive to issues, such as GBV, that affect women.
Central to this discourse however is how midwives as
women view themselves as part of the solution rather
than victims of circumstance. Their views can influence their ability to empower their clients who are
experiencing GBV. The findings from this study
could provide valuable insight to guide midwives’
practice in the therapeutic management of GBV
among pregnant women.
Study aim
This study forms the baseline of a larger study designed to improve the capacity of midwives to identify
and treat pregnant women experiencing GBV in
Jamaica. This specific component assessed midwives’
knowledge and attitudes when encountering GBV in
their practice at a maternity hospital in Kingston,
Jamaica.
Methodology
Research design
This qualitative study design was used as part of a
participatory action research study to explore midwives’ knowledge and attitudes when encountering
GBV in their practice at the antenatal clinic of a
hospital in Kingston, Jamaica. The aim was to establish
collaborative and non-exploitative relationships and
to conduct research that is transformative (Creswell,
2008). Central to this research process is the framework which is embedded in the absence and invisibility of midwives as women to see themselves as
‘‘knowers’’. Mezey et al. (2003) have also used the qualitative approach to ascertain the midwives’ perceptions and experiences of routine enquiry for domestic
violence (DV). A focus group discussion was also used
for the collection of rich narratives from this small
number of midwives working in the antenatal clinic
(Creswell, 2008).
Citation: Int J Qualitative Stud Health Well-being 2016, 11: 29358 - http://dx.doi.org/10.3402/qhw.v11.29358
Midwives’ knowledge and attitudes of gender-based violence in practice
Study setting
The study was conducted at a public hospital
that offers maternity care in Kingston, Jamaica.
The hospital operates as a teaching facility for midwives and serves clients from different social and
economic backgrounds. It is one of two maternity
hospitals that accept referrals for high-risk patients
from the 14 parishes in Jamaica. Each year, this
hospital accounts for almost 3000 of the 40,000
births island wide. The antenatal clinic serves more
than 600 pregnant women per month. These pregnant women are booked at 810 weeks’ gestation
and are cared for up to 6 weeks post-delivery. The
clinic has a staff compliment of six midwives.
Sampling technique
Purposive sampling technique was used to select all
six midwives that met the selection criteria. Creswell
(2008), Polit and Beck (2008), and Robson (2011)
recommended that 612 persons are ideal for a
focus group discussion. However, Côté-Arsenault
and Morrison-Beedy (1999) have suggested that
45 persons are acceptable when discussing emotional or sensitive topics such as GBV. The midwives
were intentionally selected because they were rich
with information based on their knowledge, working
experience, and position in the clinic (Creswell, 2008;
Robson, 2011), and often they were the first points of
contact for the pregnant women seeking care at the
institution. Midwives who met the inclusion criteria
were those who had at least 6 months uninterrupted
working experience in the antenatal clinic. Pupil
midwives were not included in the sample and midwives on temporary assigned were excluded.
Data collection procedure and instrument
Data were collected once in November 2014 through
a focus group discussion using a structured interview
guide with six midwives assigned to the antenatal
clinic in a maternity hospital in Kingston, Jamaica.
Contact was made with the midwives after obtaining
approval from the institution’s authority. Participants
were informed of the purpose of the study 4 weeks in
advance and a date was agreed upon for the discussion to be held. This was followed up with a written
invitation and telephone calls as reminders. On the
day of the focus group discussion, midwives independently provided written informed consent for their
participation. Confidentiality procedures were outlined and midwives were made aware that their
participation was voluntary. They were also advised
that they had the option to refuse or withdraw from
the discussion at any time. Midwives also completed
brief demographic questionnaires. The focus group
included a facilitator and note taker. The semistructured interview guide included open-ended
questions which explored four areas: knowledge of
GBV, midwives perceived role of GBV, midwives practice at the institution, and their willingness to participate in the development and implementation of a
protocol for screening for GBV among their clients.
The interview lasted 60 min and was audiotaped.
Data analysis
Audiotaped data were transcribed verbatim and were
analysed using content analysis. Data were read to
obtain a preliminary understanding of the text. The
text was reread several times while playing the taped
interviews, to ensure accuracy of the data transcribed. Field notes and observations of non-verbal
behaviours were incorporated into the data. Various
themes emerged and were coded into major themes
and subthemes, then interpreted and summarized.
A systematic sorting of the data (Polit & Hungler,
1995) helps to theorize that the medical model that
is practiced in Jamaica’s health care system is one
that could obscure rather than elucidate knowledge
of abuse and one that puts [midwives] under
institutional constraints (Warshaw, 1989).
Ethical consideration
Ethical approval was received from the local institutional review boards. Permission was sought and
granted from the chief executive officer, directors of
nursing, and the charge nurse at the hospital. Each
participant gave consent by completing the informed
consent form and had the opportunity to refuse after
a brief overview of the study. The participants were
asked to complete demographic data sheets before
the start of the discussion. The required steps were
observed to ensure the rights of participants were
acknowledged and safeguarded throughout the study.
The midwives were assured that their responses
would be kept confidential. The recorded discussion
was stored on a personal computer with a password
and kept for audit after data analysis. To ensure
confidentiality, each participant was assigned a name
and referred by that name during the discussion. In
addition, the Reproductive Health Survey (RHS)
(2008) found that 35.4% of ever-partnered women
aged 1545 years in Jamaica have been abused by
their intimate partner. Therefore, it is highly likely
that some midwives who have participated in the
study may have had or are currently experiencing
GBV. In keeping with Lazenbatt and ThompsonCree’s (2009) recommendation, each midwife was
given the telephone number of a 24-h DV hotline at
the end of the discussion.
Citation: Int J Qualitative Stud Health Well-being 2016, 11: 29358 - http://dx.doi.org/10.3402/qhw.v11.29358
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C. P. Pitter
Research findings
Demographic profile of midwives
The age of the six midwives who participated in the
focus group discussion ranged from 28 to 46 years
and over. They share among themselves 36 years of
experience as midwives and they have 6 months to
11 years working experience in the clinic. Three
midwives were trained at the baccalaureate level and
the other three at the certificate level.
Emerging themes
Six major themes emerged from the data, namely
midwives have suboptimal knowledge, midwives are
exposed to women experiencing GBV in pregnancy,
midwives lack professional preparedness, there are
gaps in the institutional framework to guide practice,
midwives are concerned for their safety and security,
and midwives are willing to intervene.
Theme 1: Midwives have suboptimal knowledge of GBV
All six midwives reported that they have never
received formal training but are aware of some of
the issues surrounding GBV. Some midwives reported
that GBV is very prevalent and affects everyone, but
women are more susceptible. They also stated that
GBV has more health consequences for pregnant
women. According to the midwives some women are
of the view that abuse from an intimate partner means
‘‘love’’. The midwives reported that some women will
remain in the situation because of lack of social
support whereas others will end the relationship after
the birth of the baby or when the children are all
grown up. Some midwives are of the view that secrecy
is a hindrance and is preventing meaningful interventions for women who are being abused as shown by
the quotes below:
Gender-Based Violence is treated like private
business . . . (Anna)
Some persons are afraid they might get hurt . . .
women get hurt even if reported to the police
. . . not enough attention is given to it. (Bell)
It is a big problem in our society . . . often swept
under the carpet. (Tiana)
However, despite their awareness of GBV, they have
also identified and reported that they do not know
how to effectively respond to women who are in crisis.
Theme 2: Midwives are being exposed to women
experiencing GBV in pregnancy
Despite midwives not being trained, they are still
facing the challenge of having to attend to pregnant
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women who are experiencing GBV. Three midwives recalled their encounters with pregnant
women who were experiencing GBV on several
occasions. Here are some of their experiences that
they shared:
The woman became suicidal because her
partner didn’t want her to get pregnant . . .
she was kicked out of the house. I’m not sure
how it ended. (Cindy)
In my case the lady’s husband died and left her
with a lot of money . . . she fell in love with a
younger man who wanted her to sign over all
the business to him. He cheated on her. She
had to see psychiatrist and social worker. The
case resulted in her getting over her lover and
vowing that she would live by herself with her
baby. (Anna)
It was mostly emotional with one or two
postnatal women. Half of the cases are unwanted pregnancies and their spouses had
suggested abortion. There was constant degrading of the person, ignoring the child, lack
of financial support resulting in psychological
trauma, to the point where some had suicidal
thoughts and depression after the baby was
born. I remembered a lady had a miscarriage
shortly after her beating but I am not sure if the
miscarriage was from the beating. (Tiana)
Theme 3: Lack of professional preparedness
The lack of professional preparedness created lack of
confidence and uncertainty among midwives regarding their practice. When the midwives were asked if
they were trained to manage GBV, most acknowledged that they had not received formal training
in the management of GBV by the institution or
during their span of studies. The midwives reported
that their knowledge of GBV came from society,
the media, or their own readings. All midwives were
concerned about the negative health effects of GBV
during pregnancy. They agreed that training would
give them confidence and prepare them to screen
and intervene on behalf of pregnant women who are
at risk or experiencing GBV.
Training will give us confidence. If and when
we are faced with certain situations we would
know exactly what to do. (Elsa)
Training is a good idea . . . I am ready to be a
part of the first batch . . . information is power.
However, training must correlate with other
relevant agencies such as the medical social
worker. (Tiana)
Citation: Int J Qualitative Stud Health Well-being 2016, 11: 29358 - http://dx.doi.org/10.3402/qhw.v11.29358
Midwives’ knowledge and attitudes of gender-based violence in practice
We should be certified in this area. We would
be better prepared to get involved and make a
difference. (Cindy)
Theme 4: Gaps in institutional framework to guide
practice
The study identified that there is some level of
inconsistency in the reporting of GBV among midwives in the antenatal clinic. Only two midwives
attempted to answer when they were asked about
the mechanisms for reporting GBV at their health
institution. These two midwives reported that the
patients are referred to the police or to the social
worker depending on the case. One midwife reported that it is mandatory that teenagers below the
age of consent are referred to the social worker or
police; however, the midwives were uncertain as to
who should report these cases to the police. In
addition, the midwives were concerned that there is
no opportunity for midwives to follow up with these
women. Midwives believe that they have a moral
obligation to report the crime of GBV even though
the institution does not require her to report.
In addition to the inconsistency for the reporting
of GBV, the midwives reported that there is a lack of
resources. A midwife who has been working in the
clinic shared some of the challenges she faced as a
result of a lack of resources to support pregnant
women who are experiencing GBV as follows:
As midwives we are exposed to pregnant
women who are been abused. There are times
when we want to help those persons but there
are no resources such as finances and not
enough medical social workers that we can
refer these women to. (Cindy)
Theme 5: Safety and security concerns
Safety and security emerged as a theme although the
midwives were not asked directly about it. Instead
they were asked what they think should be included
in the content of a proposed manual to guide practice.
All six midwives proposed that safety and security
should be included in the proposal. Midwives
are very concerned for their safety and security as
well as those they care for. Here are some of their
views:
There is a great need for the protection for
the family or for the woman especially when
children are involved. We need to protect them.
(Cindy)
The proposal should cover protection for the
midwives and the health team. (Tiana)
One midwife believes that the protection of their
safety and security could empower them and give
them the right to intervene.
Theme 6: Midwives are willing to intervene
Midwives’ perceived role in responding to pregnant
women who are experiencing GBV. All midwives reported that they do have a role in identifying GBV
among pregnant women and consider themselves to
be advocates. They believe that they are morally
obligated to report GBV although it is not mandated
by law or required by the hospital. They strongly
believe that they should have an input in the development of a proposed protocol to guide their practice.
In addition, they believe that brochures with GBV
information should be available to pregnant women.
The midwives also believe that separate and apart
from asking the patients, there are other covert signs
to identify those at risk, such as improperly dressed,
unkempt, depressed, elevated vital signs, not sleeping, and obvious physical trauma. The midwives
reported that there are other indirect signs such as:
A controlling partner wants to know everything and follows his spouse around. He may
be controlling and she doesn’t want to say it
in front of him. You might pick up on that
one. (Belle)
Absenteeism from clinic, or whenever the
woman comes she might be a bit withdrawn.
The woman may display abusive behaviour
toward the staff or even to her children that
accompany her to the clinic. (Elsa)
Some of them tell-tales such as hitting up in the
door . . . these things should be investigated.
(Tiana)
The midwives have also reported that they are willing
to be trained and participate in the development of a
protocol to screen for GBV in maternity care.
Discussion
This is a groundbreaking study conducted in Jamaica
which has highlighted the knowledge and attitude of
midwives when encountering GBV in their practice.
With a prevalence of 34.5% of ever-partnered women
experiencing GBV in the general population (RHS,
2008) and a prevalence of 36% among pregnant
women (Pitter & Dunn, 2015, unpublished data),
GBV in Jamaica by all accounts is a serious and
widespread crime. Still many cases continue to go
unreported and undetected mainly because GBV is
intrinsically linked to the social and cultural norms,
Citation: Int J Qualitative Stud Health Well-being 2016, 11: 29358 - http://dx.doi.org/10.3402/qhw.v11.29358
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C. P. Pitter
stigma, and fear of retribution or for further violence
(Country Information and Guidance, 2015). Some of
these reasons occur in the context of gender inequality and specific cultural beliefs and attitudes about
gender roles, especially those concerning male and
female sexuality and a pattern of economic inequality
United States Agency for International Development
(USAID, n.d.-a). The health care systems in many
jurisdictions have proven to be successful in identifying and treating victims of GBV (USAID, n.d.-b).
However, there seems to be an oversight in Jamaica’s
health care system, especially in maternity care.
This could be viewed as an indictment for Jamaica
to achieve several international goals which seek to
eliminate violence against women (VAW), for which
Jamaica is signatory to.
All midwives in this study have reported that they
have some insight on issues surrounding GBV but in
the final analysis they have admitted that they do not
have the competence or confidence to effectively
respond to pregnant women in crisis. Neither are
these midwives professionally prepared nor have they
any institutional framework to guide their practice.
The midwives believe that training in GBV will
increase the rate of detection in maternity settings,
thereby providing an opportunity for women to
access help early (Bacchus et al., 2004). Although
there may be widespread concerns for mandatory
screening for GBV in health care (Jezierski, 1999),
the Maternal and Child Health Care for Vulnerable
Mothers project has found that having a clinical pathway and guidelines will provide greater opportunity
for GBV discussions to occur (Taft et al., 2015).
Moreover, there is a growing consensus that providing opportunities in maternity centres to enquiry
about GBV will heighten the awareness of GBV
among women (Undie, Maternowska, Mak’anyengo,
& Askew, 2015).
The World Health Organization (2006) has called
for the integration of gender as it relates to violence
into the curricula for health professionals as it is
widely believed that these professionals are uniquely
placed to address issues such as GBV. The problem
is that GBV is not included in the educational curricula of health professionals in some schools (Keeling,
2002) such as midwifery. Therefore, it is not surprising that midwives in Jamaica would lack the
knowledge and confidence to initiate or engage
discussions on this important topic among their
clientele.
Midwives are in a position of great respect and
influence (RHS, 2008); they are on the front line for
reducing intergenerational violence by identifying
and treating pregnant women who are experiencing
GBV (WHA 49.25, 1996). This study has found that
midwives are exposed to women in crisis despite not
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been equipped to address the issue of GBV. This has
left the midwives to draw conclusions about who
they perceived to be experiencing abuse by observing
the behaviours of clients and/or the interactions of
clients with their spouses. When faced with such
challenges, the midwives are unsure as to what they
are to report and to whom they are to report cases
of GBV to; on many occasions, midwives wondered
what had happened to their clients and were left with
many unanswered concerns (McCosker-Howard,
Kain, Anderson, & Webster, 2005). This practice is
contrary to the American Association of Colleges
of Nursing (AACN) (1999) best practice guidelines
for nurses in responding to GBV. These guidelines
include the acknowledgment of the problem, the
utilization of assessment skills to identify and document abuse and its health effects, legal and ethical
issues in treating and reporting, and activities to
prevent domestic violence. The AACN guidelines compliment the recommendation from USAID
(n.d.-b) that urged the health systems to respond
with linkages to legal and social services to support
women survivors of violence.
Despite all the challenges, midwives in this study
and other studies remain committed; they feel
morally obligated and are willing to intervene on
behalf of their clients (Lazenbatt & Thompson-Cree,
2009; McCosker-Howard et al., 2005). This is in
contrast to the Mezey et al. (2003) groundbreaking
study which found that despite being trained, midwives were not keen on screening for GBV. Some of
the reasons they gave were lack of motivation and
enthusiasm, insufficient time, and screening for GBV
was added workload. This was not the case in this
study as the midwives interviewed had a positive
attitude; they remain hopeful and viewed GBV as a
priority that needs urgent attention. I am suggesting
that strategies to reinforce such positive attitudes
should include measures to manage difficult conversations as well as ensure professional development
of midwives for them to be better at responding to
women in crisis. Mezey et al. (2003) warned that
although midwives have caring attitudes and feel
morally obligated to intervene on behalf of their
clients, the perceived barriers in a busy maternity
service should not be overlooked as these could limit
the encounter when the woman is distressed.
Although the midwives were not asked directly
about safety and security issues, all are cognizant of
the threats and the impact this could have on the
lives of midwives and those they care for. This
finding underscores the Mezey et al. (2003) warning
that these issues should not be undermined as this
could lead to some potentially dangerous and certainly threatening encounters with irate partners,
especially when the women attempt to seek help.
Citation: Int J Qualitative Stud Health Well-being 2016, 11: 29358 - http://dx.doi.org/10.3402/qhw.v11.29358
Midwives’ knowledge and attitudes of gender-based violence in practice
These factors should not be overlooked by our
local authority given the high incidence of violence
in our country. Fortunately, these challenges however have not prevented midwives in this study from
intervening on behalf of clients that are reporting
GBV.
The lack of screening for GBV in the antenatal
clinic could be seen as a lost opportunity for midwives to break the cycle of violence. I believe that
midwives should capitalize on this window of opportunity to intervene and advocate for their clients
and not to delay the process because of a lack of
framework to guide practice. This can be accomplished by raising the awareness of GBV among the
users of the clinic, targeting both mothers and their
partners, and utilizing the referral system to identify
pregnant women who are experiencing or at risk
for GBV.
The overwhelming evidence has demonstrated
that training of midwives to address culturally
sensitive issues such as GBV should be top priority
as it will help protect the lives of the pregnant women
and their infants. This proposed approach calls for
midwives who are predominately women providing
the evidence to be included at the decision making
table and get their voices heard.
Conclusion
This is the first study in Jamaica that highlights
midwives’ thoughts and voices as well as sheds light
on such a neglected but important issue that they
encounter while giving care. A great deal of focus has
been placed on achieving the MDGs #45; however,
what is repeatedly overlooked is a methodology to
identify GBV in maternity centres in Jamaica. Given
the physical and mental health manifestations of
intimate partner abuse, it is very important that the
health system remains an important component of a
coordinated response to GBV (Laing, 2003). The
findings of the study are an important link in the
prevention framework to eliminate VAW and the call
for action. The study also emphasized that midwives
are central in any multisectoral response to eliminate
GBV among pregnant women. Asking about GBV
in pregnancy is an important step for midwives to
address this national priority. The study further
confirmed midwives’ awareness of the issue, but
their capacity to intervene is hindered by their lack of
professional preparedness and institutional framework to guide their practice. Considering these factors
could support a climate of change and provide
support for both midwives and pregnant women.
Training midwives in GBV should be a priority not
just for this institution but for maternity care services
in Jamaica. This could lead to raising the awareness
and effects of GBV in pregnancy and assist pregnant
women to examine their relationship and their helpseeking behaviour.
Relevance
Findings from this study will be incorporated with
the findings from the larger study to inform midwifery education and practice in Jamaica. The findings will also be used to inform a screening protocol
in maternity care. This could also broaden the
discussion on the effects of GBV in pregnancy on
the MDGs as it relates to the inability of Jamaica to
significantly reduce the maternal and infant mortality rates. Findings could be incorporated in the
national strategies to support linkages between law
enforcement, health services, and other services to
eliminate GBV in Jamaica.
Limitations
Although findings from this study provide important
information on the knowledge and attitude of midwives when encountering GBV in their practice,
limitations to the study do exist. The sample included only a limited number of midwives in an
antenatal clinic in one Kingston-based hospital. This
limits the number of midwives in the institution and
more so other maternity centres in Jamaica. Another
major limitation of the study was that no information
from the pregnant women was included in the study.
The results of this study should be interpreted
carefully because they are derived from this single
preliminary investigation.
Author’s contribution
The author takes responsibility for the study design,
implementation and interpretation of the results, as
well as the content of this article.
Acknowledgements
The author is most grateful to Dr. Leith Dunn, her
research supervisor at the Institute for Gender &
Development Studies, UWI- Mona Unit, for her
valuable guidance and also the midwives who
participated in the study.
Conflict of interest and funding
There are no conflicts of interest. The author alone is
responsible for the content and writing of the paper.
Personal funds were used to conduct the study.
Citation: Int J Qualitative Stud Health Well-being 2016, 11: 29358 - http://dx.doi.org/10.3402/qhw.v11.29358
7
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C. P. Pitter
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